Miscarriage Care and Facilities in Scotland: Scoping Report NHS Forth Valley

Management options

In NHS Forth Valley women were provided with full explanations about what would happen during their chosen method of management, after the chosen method of management, and in terms of follow-up. Women were free to choose their preferred management approach based on their needs and preferences.

All treatment options for miscarriage care, detailed below (Table 16), were offered at the Royal Hospital during first trimester losses, with the exception of medical management with misoprostol which was not offered for any trimester.

All sites were asked to fully describe the treatment pathway for expectant management, medical management, and surgical management. The descriptions provided have been presented under the relevant subheadings below; these narratives contain only information provided by the sites during this exercise.

Expectant management in NHS Forth Valley

The questionnaire asked about the advice given to women about expectant management of miscarriage. In NHS Forth Valley expectant management is the first line management opton and women are provided with leaflets which fully explain the risks associated with expectant management, the rates of success and the follow up involved. Leaflets also include contact details and 24 hour advice contacts. If expectant management is chosen, face to face reviews are organised to exclude sepsis and to carry out an ultra sound scan (USS) after a week of expectant management. After this, management options are rediscussed with the patient. If it is decided to continue with expectant management, then a further review is arranged for one week later. A weekly review continues until products of conception (POC) are passed with antibiotic cover from 2 weeks.

Medical management in NHS Forth Valley

The pathway of care for medical management at Forth Valley Royal Hospital begins with a discussion of the benefits and risks of this management pathway with the patient. This includes information on the process, follow up, and what to expect while at home. Contact numbers for the ward and escalation advice are also provided. Medical management with mifepristone and misoprostol is offered, with doses dependent on the gestation. Options for home management are available for those under 11 weeks and 6 days. Inpatient medical management is offered under 11 weeks and 6 days gestation, where there is an idication to do so, such as in unsuitable home circumstances, if the woman is clinically unstable or has comorbidities.

For inpatient management, POC are confirmed to have passed before women are allowed home with a pregnancy test to be taken three weeks later. They are asked to return to hospital if this test is positive. If no POC are passed and they are under 9 weeks gestation, women will go home with a scan arranged for one week later. If they are over 9 weeks gestation a scan is performed whilst they are an inpatient and further management instigated. For outpatient management in the first trimester, women are asked to contact the site if no POC passed. An USS is then arranged within a week. If history suggests the treatment has succeeded at home then patients are asked to perform a pregnancy test in 3 weeks.

Surgical management in NHS Forth Valley

The treatment pathway for surgical management described by Forth Valley Royal Hospital involves a full discussion of the risks and benefits associated with the process, rates of success and alternative options available. Women are provided with information about what to expect during and after treatment, as well as advice on escalation and 24 hour contact numbers for the ward.

In NHS Forth Valley surgical management with manual vacuum aspiration (MVA) with local anaesthetic is offered in the first trimester and surgical management under general anaesthetic is offered in first and second trimester. Surgical management may include inpatient general anesthetic, misoprostol cervical ripening and suction termination. Following surgical management a pregnancy test would be given to be performed at home 3 weeks after procedure.